The WSJ has an article this week discussing MRI and breast sonogram as adjuncts to mammogram, and the debate going on in the medical community as to how these modalities should be used. The article does a nice job framing the debate that is occurring among physicians regarding when to use these modalities.
Medical practitioners are divided about the proper role of ultrasound in breast-cancer screening. Wendie Berg, a radiologist at a clinic in Lutherville, Md., who was the lead author of the study published in JAMA, says she recommends ultrasound screening to some women who don’t have evidence of very high risk that would justify an MRI. “It is a judgment call. The denser the breast, the more difficult the mammogram is to read, the more likely I am to recommend an ultrasound,” she says.
But Constance Lehman, a University of Washington professor of radiology who led a study published last year in the New England Journal on MRI screening, says she never advises ultrasound for patients. “We find it ineffective as a screening tool,” she says. “It’s not even in the same ballpark” as an MRI.
I’ve been actively debating the songram issue with an internal medicine colleague. She’s anti-sono, I tend to favor the screening method, but with caveats. She and I decided the issue is pervasive enough to discuss publicly, and are setting up a debate forum this fall with a panel of respected breast specialists and radiologists to see if we can come to some resolution on the matter.
Will let y’all know how that turns out.
Looking forward to the update.
Yes, I am looking forward to this update, too!
The place I go to have my annual mammogram – completes the mammogram then has a radiologist look at it immediately. If there seems to be something suspicious or the tissue is really dense – they do an ultrasound or MRI right then (so you don’t have to reschedule)…then, they have the radiologist look at that film. While you don’t get the FINAL reading until your doctor calls – it sure beats being told that your mammogram is “shady” and then having to make another appt for an ultrasound/MRI.
Hi doc,
My first post here. I’m a sonographer, but not practicing at this time. I’m doing medical editing and research.
From all I know about US physics, and that’s a LOT, I can only say that US should be a 2nd line of defense, not a 1st. It is faahhhhbulous at defining cystic from solid, and the probes are getting better and better with higher and higher frequencies (15 Mhz – great resolution). New color flow technologies are helpful too. But it will not show calcifications – ever, as far as i can tell – as being monomorphic vs pleomorphic vs vascular. It’s just not there yet. It will show cysts, fibroadenomas, and spiculation really well, but calcifications are a huge entity to leave out of the picture, and globally, I just don’t think US is there yet, no matter how much cheaper it is than MR or how much it has improved. It’s for an adjuvant look at the breast, in my opinion. For confirming or excluding stuff already seen on mammo or MR.
Just one woman’s opinion. . .
kcd (kathleen)
Great topic, can’t wait to hear about the discussion!
I’m hoping you also comment on use of ultrasound after mammograms. I had my annual mammogram, then was called back for additional mammo views and an ultrasound and I bet this is common.
sorry i posted twice. huge DUH.
texas reader, ultrasound tends to see what mammogram can’t and that’s why they work so well together. dense breasts aren’t always well seen on mammo but ultrasound can see them better.
again sorry for the department of redundancy department on my part.
kcd